Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

REMOVAL OF INTRAUTERINE DEVICE (IUD)

Facility

$835.10

Service Code	CPT 58301
Hospital Revenue Code	360
Min. Negotiated Rate	$159.02
Max. Negotiated Rate	$835.10
Rate for Payer: Aetna Medicare	$308.54
Rate for Payer: Allen County Amish Medical Aid Commercial	$370.84
Rate for Payer: Amish Plain Church Group Commercial	$370.84
Rate for Payer: BCBS Complete	$166.97
Rate for Payer: BCBS MAPPO	$296.67
Rate for Payer: BCN Medicare Advantage	$296.67
Rate for Payer: Health Alliance Plan Medicare Advantage	$296.67
Rate for Payer: Mclaren Medicaid	$159.02
Rate for Payer: Mclaren Medicare	$296.67
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$311.50
Rate for Payer: Meridian Medicaid	$166.97
Rate for Payer: MI Amish Medical Board Commercial	$341.17
Rate for Payer: PACE Medicare	$281.84
Rate for Payer: PACE SWMI	$296.67
Rate for Payer: PHP Medicare Advantage	$296.67
Rate for Payer: Priority Health Choice Medicaid	$159.02
Rate for Payer: Priority Health Medicare	$296.67
Rate for Payer: Railroad Medicare Medicare	$296.67
Rate for Payer: UHC All Payor (Choice/PPO)	$835.10
Rate for Payer: UHC Dual Complete DSNP	$296.67
Rate for Payer: UHC Exchange	$566.97
Rate for Payer: UHC Medicare Advantage	$296.67
Rate for Payer: UHCCP Medicaid	$159.02
Rate for Payer: VA VA	$296.67

REMOVAL OF LENS MATERIAL; EXTRACAPSULAR (OTHER THAN 66840, 66850, 66852)

Facility

$6,261.32

Service Code	CPT 66940
Hospital Revenue Code	360
Min. Negotiated Rate	$1,192.25
Max. Negotiated Rate	$6,261.32
Rate for Payer: Aetna Medicare	$2,313.32
Rate for Payer: Allen County Amish Medical Aid Commercial	$2,780.44
Rate for Payer: Amish Plain Church Group Commercial	$2,780.44
Rate for Payer: BCBS Complete	$1,251.86
Rate for Payer: BCBS MAPPO	$2,224.35
Rate for Payer: BCN Medicare Advantage	$2,224.35
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,224.35
Rate for Payer: Mclaren Medicaid	$1,192.25
Rate for Payer: Mclaren Medicare	$2,224.35
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$2,335.57
Rate for Payer: Meridian Medicaid	$1,251.86
Rate for Payer: MI Amish Medical Board Commercial	$2,558.00
Rate for Payer: PACE Medicare	$2,113.13
Rate for Payer: PACE SWMI	$2,224.35
Rate for Payer: PHP Medicare Advantage	$2,224.35
Rate for Payer: Priority Health Choice Medicaid	$1,192.25
Rate for Payer: Priority Health Medicare	$2,224.35
Rate for Payer: Railroad Medicare Medicare	$2,224.35
Rate for Payer: UHC All Payor (Choice/PPO)	$6,261.32
Rate for Payer: UHC Dual Complete DSNP	$2,224.35
Rate for Payer: UHC Exchange	$4,250.96
Rate for Payer: UHC Medicare Advantage	$2,224.35
Rate for Payer: UHCCP Medicaid	$1,192.25
Rate for Payer: VA VA	$2,224.35

REMOVAL OF LENS MATERIAL; INTRACAPSULAR

Facility

$6,261.32

Service Code	CPT 66920
Hospital Revenue Code	360
Min. Negotiated Rate	$1,192.25
Max. Negotiated Rate	$6,261.32
Rate for Payer: Aetna Medicare	$2,313.32
Rate for Payer: Allen County Amish Medical Aid Commercial	$2,780.44
Rate for Payer: Amish Plain Church Group Commercial	$2,780.44
Rate for Payer: BCBS Complete	$1,251.86
Rate for Payer: BCBS MAPPO	$2,224.35
Rate for Payer: BCN Medicare Advantage	$2,224.35
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,224.35
Rate for Payer: Mclaren Medicaid	$1,192.25
Rate for Payer: Mclaren Medicare	$2,224.35
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$2,335.57
Rate for Payer: Meridian Medicaid	$1,251.86
Rate for Payer: MI Amish Medical Board Commercial	$2,558.00
Rate for Payer: PACE Medicare	$2,113.13
Rate for Payer: PACE SWMI	$2,224.35
Rate for Payer: PHP Medicare Advantage	$2,224.35
Rate for Payer: Priority Health Choice Medicaid	$1,192.25
Rate for Payer: Priority Health Medicare	$2,224.35
Rate for Payer: Railroad Medicare Medicare	$2,224.35
Rate for Payer: UHC All Payor (Choice/PPO)	$6,261.32
Rate for Payer: UHC Dual Complete DSNP	$2,224.35
Rate for Payer: UHC Exchange	$4,250.96
Rate for Payer: UHC Medicare Advantage	$2,224.35
Rate for Payer: UHCCP Medicaid	$1,192.25
Rate for Payer: VA VA	$2,224.35

REMOVAL OF LENS MATERIAL; PHACOFRAGMENTATION TECHNIQUE (MECHANICAL OR ULTRASONIC) (EG, PHACOEMULSIFICATION), WITH ASPIRATION

Facility

$6,261.32

Service Code	CPT 66850
Hospital Revenue Code	360
Min. Negotiated Rate	$1,192.25
Max. Negotiated Rate	$6,261.32
Rate for Payer: Aetna Medicare	$2,313.32
Rate for Payer: Allen County Amish Medical Aid Commercial	$2,780.44
Rate for Payer: Amish Plain Church Group Commercial	$2,780.44
Rate for Payer: BCBS Complete	$1,251.86
Rate for Payer: BCBS MAPPO	$2,224.35
Rate for Payer: BCN Medicare Advantage	$2,224.35
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,224.35
Rate for Payer: Mclaren Medicaid	$1,192.25
Rate for Payer: Mclaren Medicare	$2,224.35
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$2,335.57
Rate for Payer: Meridian Medicaid	$1,251.86
Rate for Payer: MI Amish Medical Board Commercial	$2,558.00
Rate for Payer: PACE Medicare	$2,113.13
Rate for Payer: PACE SWMI	$2,224.35
Rate for Payer: PHP Medicare Advantage	$2,224.35
Rate for Payer: Priority Health Choice Medicaid	$1,192.25
Rate for Payer: Priority Health Medicare	$2,224.35
Rate for Payer: Railroad Medicare Medicare	$2,224.35
Rate for Payer: UHC All Payor (Choice/PPO)	$6,261.32
Rate for Payer: UHC Dual Complete DSNP	$2,224.35
Rate for Payer: UHC Exchange	$4,250.96
Rate for Payer: UHC Medicare Advantage	$2,224.35
Rate for Payer: UHCCP Medicaid	$1,192.25
Rate for Payer: VA VA	$2,224.35

REMOVAL OF NEPHROSTOMY TUBE, REQUIRING FLUOROSCOPIC GUIDANCE (EG, WITH CONCURRENT INDWELLING URETERAL STENT)

Facility

$1,832.42

Service Code	CPT 50389
Hospital Revenue Code	360
Min. Negotiated Rate	$348.92
Max. Negotiated Rate	$1,832.42
Rate for Payer: Aetna Medicare	$677.01
Rate for Payer: Allen County Amish Medical Aid Commercial	$813.71
Rate for Payer: Amish Plain Church Group Commercial	$813.71
Rate for Payer: BCBS Complete	$366.37
Rate for Payer: BCBS MAPPO	$650.97
Rate for Payer: BCN Medicare Advantage	$650.97
Rate for Payer: Health Alliance Plan Medicare Advantage	$650.97
Rate for Payer: Mclaren Medicaid	$348.92
Rate for Payer: Mclaren Medicare	$650.97
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$683.52
Rate for Payer: Meridian Medicaid	$366.37
Rate for Payer: MI Amish Medical Board Commercial	$748.62
Rate for Payer: PACE Medicare	$618.42
Rate for Payer: PACE SWMI	$650.97
Rate for Payer: PHP Medicare Advantage	$650.97
Rate for Payer: Priority Health Choice Medicaid	$348.92
Rate for Payer: Priority Health Medicare	$650.97
Rate for Payer: Railroad Medicare Medicare	$650.97
Rate for Payer: UHC All Payor (Choice/PPO)	$1,832.42
Rate for Payer: UHC Dual Complete DSNP	$650.97
Rate for Payer: UHC Exchange	$1,244.07
Rate for Payer: UHC Medicare Advantage	$650.97
Rate for Payer: UHCCP Medicaid	$348.92
Rate for Payer: VA VA	$650.97

REMOVAL OF PROSTHESIS, INCLUDES DEBRIDEMENT AND SYNOVECTOMY WHEN PERFORMED; HUMERAL OR GLENOID COMPONENT

Facility

$7,857.23

Service Code	CPT 23334
Hospital Revenue Code	360
Min. Negotiated Rate	$1,496.14
Max. Negotiated Rate	$7,857.23
Rate for Payer: Aetna Medicare	$2,902.95
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,489.12
Rate for Payer: Amish Plain Church Group Commercial	$3,489.12
Rate for Payer: BCBS Complete	$1,570.94
Rate for Payer: BCBS MAPPO	$2,791.30
Rate for Payer: BCN Medicare Advantage	$2,791.30
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,791.30
Rate for Payer: Mclaren Medicaid	$1,496.14
Rate for Payer: Mclaren Medicare	$2,791.30
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$2,930.86
Rate for Payer: Meridian Medicaid	$1,570.94
Rate for Payer: MI Amish Medical Board Commercial	$3,209.99
Rate for Payer: PACE Medicare	$2,651.74
Rate for Payer: PACE SWMI	$2,791.30
Rate for Payer: PHP Medicare Advantage	$2,791.30
Rate for Payer: Priority Health Choice Medicaid	$1,496.14
Rate for Payer: Priority Health Medicare	$2,791.30
Rate for Payer: Railroad Medicare Medicare	$2,791.30
Rate for Payer: UHC All Payor (Choice/PPO)	$7,857.23
Rate for Payer: UHC Dual Complete DSNP	$2,791.30
Rate for Payer: UHC Exchange	$5,334.45
Rate for Payer: UHC Medicare Advantage	$2,791.30
Rate for Payer: UHCCP Medicaid	$1,496.14
Rate for Payer: VA VA	$2,791.30

REMOVAL OF RUPTURED BREAST IMPLANT, INCLUDING IMPLANT CONTENTS (EG, SALINE, SILICONE GEL)

Facility

$10,512.58

Service Code	CPT 19330
Hospital Revenue Code	360
Min. Negotiated Rate	$2,001.76
Max. Negotiated Rate	$10,512.58
Rate for Payer: Aetna Medicare	$3,884.00
Rate for Payer: Allen County Amish Medical Aid Commercial	$4,668.27
Rate for Payer: Amish Plain Church Group Commercial	$4,668.27
Rate for Payer: BCBS Complete	$2,101.84
Rate for Payer: BCBS MAPPO	$3,734.62
Rate for Payer: BCN Medicare Advantage	$3,734.62
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,734.62
Rate for Payer: Mclaren Medicaid	$2,001.76
Rate for Payer: Mclaren Medicare	$3,734.62
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$3,921.35
Rate for Payer: Meridian Medicaid	$2,101.84
Rate for Payer: MI Amish Medical Board Commercial	$4,294.81
Rate for Payer: PACE Medicare	$3,547.89
Rate for Payer: PACE SWMI	$3,734.62
Rate for Payer: PHP Medicare Advantage	$3,734.62
Rate for Payer: Priority Health Choice Medicaid	$2,001.76
Rate for Payer: Priority Health Medicare	$3,734.62
Rate for Payer: Railroad Medicare Medicare	$3,734.62
Rate for Payer: UHC All Payor (Choice/PPO)	$10,512.58
Rate for Payer: UHC Dual Complete DSNP	$3,734.62
Rate for Payer: UHC Exchange	$7,137.23
Rate for Payer: UHC Medicare Advantage	$3,734.62
Rate for Payer: UHCCP Medicaid	$2,001.76
Rate for Payer: VA VA	$3,734.62

REMOVAL OF SKIN TAGS, MULTIPLE FIBROCUTANEOUS TAGS, ANY AREA; UP TO AND INCLUDING 15 LESIONS

Facility

$545.50

Service Code	CPT 11200
Hospital Revenue Code	360
Min. Negotiated Rate	$103.87
Max. Negotiated Rate	$545.50
Rate for Payer: Aetna Medicare	$201.54
Rate for Payer: Allen County Amish Medical Aid Commercial	$242.24
Rate for Payer: Amish Plain Church Group Commercial	$242.24
Rate for Payer: BCBS Complete	$109.07
Rate for Payer: BCBS MAPPO	$193.79
Rate for Payer: BCN Medicare Advantage	$193.79
Rate for Payer: Health Alliance Plan Medicare Advantage	$193.79
Rate for Payer: Mclaren Medicaid	$103.87
Rate for Payer: Mclaren Medicare	$193.79
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$203.48
Rate for Payer: Meridian Medicaid	$109.07
Rate for Payer: MI Amish Medical Board Commercial	$222.86
Rate for Payer: PACE Medicare	$184.10
Rate for Payer: PACE SWMI	$193.79
Rate for Payer: PHP Medicare Advantage	$193.79
Rate for Payer: Priority Health Choice Medicaid	$103.87
Rate for Payer: Priority Health Medicare	$193.79
Rate for Payer: Railroad Medicare Medicare	$193.79
Rate for Payer: UHC All Payor (Choice/PPO)	$545.50
Rate for Payer: UHC Dual Complete DSNP	$193.79
Rate for Payer: UHC Exchange	$370.35
Rate for Payer: UHC Medicare Advantage	$193.79
Rate for Payer: UHCCP Medicaid	$103.87
Rate for Payer: VA VA	$193.79

REMOVAL OF SKIN TAGS, MULTIPLE FIBROCUTANEOUS TAGS, ANY AREA; UP TO AND INCLUDING 15 LESIONS

Facility

$545.50

Service Code	CPT 11200
Hospital Revenue Code	361
Min. Negotiated Rate	$103.87
Max. Negotiated Rate	$545.50
Rate for Payer: Aetna Medicare	$201.54
Rate for Payer: Allen County Amish Medical Aid Commercial	$242.24
Rate for Payer: Amish Plain Church Group Commercial	$242.24
Rate for Payer: BCBS Complete	$109.07
Rate for Payer: BCBS MAPPO	$193.79
Rate for Payer: BCN Medicare Advantage	$193.79
Rate for Payer: Health Alliance Plan Medicare Advantage	$193.79
Rate for Payer: Mclaren Medicaid	$103.87
Rate for Payer: Mclaren Medicare	$193.79
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$203.48
Rate for Payer: Meridian Medicaid	$109.07
Rate for Payer: MI Amish Medical Board Commercial	$222.86
Rate for Payer: PACE Medicare	$184.10
Rate for Payer: PACE SWMI	$193.79
Rate for Payer: PHP Medicare Advantage	$193.79
Rate for Payer: Priority Health Choice Medicaid	$103.87
Rate for Payer: Priority Health Medicare	$193.79
Rate for Payer: Railroad Medicare Medicare	$193.79
Rate for Payer: UHC All Payor (Choice/PPO)	$545.50
Rate for Payer: UHC Dual Complete DSNP	$193.79
Rate for Payer: UHC Exchange	$370.35
Rate for Payer: UHC Medicare Advantage	$193.79
Rate for Payer: UHCCP Medicaid	$103.87
Rate for Payer: VA VA	$193.79

REMOVAL OF SPINAL NEUROSTIMULATOR ELECTRODE PERCUTANEOUS ARRAY(S), INCLUDING FLUOROSCOPY, WHEN PERFORMED

Facility

$5,360.98

Service Code	CPT 63661
Hospital Revenue Code	360
Min. Negotiated Rate	$1,020.81
Max. Negotiated Rate	$5,360.98
Rate for Payer: Aetna Medicare	$1,980.68
Rate for Payer: Allen County Amish Medical Aid Commercial	$2,380.62
Rate for Payer: Amish Plain Church Group Commercial	$2,380.62
Rate for Payer: BCBS Complete	$1,071.85
Rate for Payer: BCBS MAPPO	$1,904.50
Rate for Payer: BCN Medicare Advantage	$1,904.50
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,904.50
Rate for Payer: Mclaren Medicaid	$1,020.81
Rate for Payer: Mclaren Medicare	$1,904.50
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,999.72
Rate for Payer: Meridian Medicaid	$1,071.85
Rate for Payer: MI Amish Medical Board Commercial	$2,190.18
Rate for Payer: PACE Medicare	$1,809.28
Rate for Payer: PACE SWMI	$1,904.50
Rate for Payer: PHP Medicare Advantage	$1,904.50
Rate for Payer: Priority Health Choice Medicaid	$1,020.81
Rate for Payer: Priority Health Medicare	$1,904.50
Rate for Payer: Railroad Medicare Medicare	$1,904.50
Rate for Payer: UHC All Payor (Choice/PPO)	$5,360.98
Rate for Payer: UHC Dual Complete DSNP	$1,904.50
Rate for Payer: UHC Exchange	$3,639.69
Rate for Payer: UHC Medicare Advantage	$1,904.50
Rate for Payer: UHCCP Medicaid	$1,020.81
Rate for Payer: VA VA	$1,904.50

REMOVAL OF SPINAL NEUROSTIMULATOR ELECTRODE PLATE/PADDLE(S) PLACED VIA LAMINOTOMY OR LAMINECTOMY, INCLUDING FLUOROSCOPY, WHEN PERFORMED

Facility

$9,441.17

Service Code	CPT 63662
Hospital Revenue Code	360
Min. Negotiated Rate	$1,797.74
Max. Negotiated Rate	$9,441.17
Rate for Payer: Aetna Medicare	$3,488.16
Rate for Payer: Allen County Amish Medical Aid Commercial	$4,192.50
Rate for Payer: Amish Plain Church Group Commercial	$4,192.50
Rate for Payer: BCBS Complete	$1,887.63
Rate for Payer: BCBS MAPPO	$3,354.00
Rate for Payer: BCN Medicare Advantage	$3,354.00
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,354.00
Rate for Payer: Mclaren Medicaid	$1,797.74
Rate for Payer: Mclaren Medicare	$3,354.00
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$3,521.70
Rate for Payer: Meridian Medicaid	$1,887.63
Rate for Payer: MI Amish Medical Board Commercial	$3,857.10
Rate for Payer: PACE Medicare	$3,186.30
Rate for Payer: PACE SWMI	$3,354.00
Rate for Payer: PHP Medicare Advantage	$3,354.00
Rate for Payer: Priority Health Choice Medicaid	$1,797.74
Rate for Payer: Priority Health Medicare	$3,354.00
Rate for Payer: Railroad Medicare Medicare	$3,354.00
Rate for Payer: UHC All Payor (Choice/PPO)	$9,441.17
Rate for Payer: UHC Dual Complete DSNP	$3,354.00
Rate for Payer: UHC Exchange	$6,409.83
Rate for Payer: UHC Medicare Advantage	$3,354.00
Rate for Payer: UHCCP Medicaid	$1,797.74
Rate for Payer: VA VA	$3,354.00

REMOVAL OF SUTURES OR STAPLES REQUIRING ANESTHESIA (IE, GENERAL ANESTHESIA, MODERATE SEDATION)

Facility

$5,021.81

Service Code	CPT 15851
Hospital Revenue Code	360
Min. Negotiated Rate	$956.23
Max. Negotiated Rate	$5,021.81
Rate for Payer: Aetna Medicare	$1,855.37
Rate for Payer: Allen County Amish Medical Aid Commercial	$2,230.01
Rate for Payer: Amish Plain Church Group Commercial	$2,230.01
Rate for Payer: BCBS Complete	$1,004.04
Rate for Payer: BCBS MAPPO	$1,784.01
Rate for Payer: BCN Medicare Advantage	$1,784.01
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,784.01
Rate for Payer: Mclaren Medicaid	$956.23
Rate for Payer: Mclaren Medicare	$1,784.01
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,873.21
Rate for Payer: Meridian Medicaid	$1,004.04
Rate for Payer: MI Amish Medical Board Commercial	$2,051.61
Rate for Payer: PACE Medicare	$1,694.81
Rate for Payer: PACE SWMI	$1,784.01
Rate for Payer: PHP Medicare Advantage	$1,784.01
Rate for Payer: Priority Health Choice Medicaid	$956.23
Rate for Payer: Priority Health Medicare	$1,784.01
Rate for Payer: Railroad Medicare Medicare	$1,784.01
Rate for Payer: UHC All Payor (Choice/PPO)	$5,021.81
Rate for Payer: UHC Dual Complete DSNP	$1,784.01
Rate for Payer: UHC Exchange	$3,409.42
Rate for Payer: UHC Medicare Advantage	$1,784.01
Rate for Payer: UHCCP Medicaid	$956.23
Rate for Payer: VA VA	$1,784.01

REMOVAL OF SYNTHETIC ROD AND INSERTION OF FLEXOR TENDON GRAFT, HAND OR FINGER (INCLUDES OBTAINING GRAFT), EACH ROD

Facility

$19,611.80

Service Code	CPT 26392
Hospital Revenue Code	360
Min. Negotiated Rate	$3,734.39
Max. Negotiated Rate	$19,611.80
Rate for Payer: Aetna Medicare	$7,245.83
Rate for Payer: Allen County Amish Medical Aid Commercial	$8,708.92
Rate for Payer: Amish Plain Church Group Commercial	$8,708.92
Rate for Payer: BCBS Complete	$3,921.11
Rate for Payer: BCBS MAPPO	$6,967.14
Rate for Payer: BCN Medicare Advantage	$6,967.14
Rate for Payer: Health Alliance Plan Medicare Advantage	$6,967.14
Rate for Payer: Mclaren Medicaid	$3,734.39
Rate for Payer: Mclaren Medicare	$6,967.14
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$7,315.50
Rate for Payer: Meridian Medicaid	$3,921.11
Rate for Payer: MI Amish Medical Board Commercial	$8,012.21
Rate for Payer: PACE Medicare	$6,618.78
Rate for Payer: PACE SWMI	$6,967.14
Rate for Payer: PHP Medicare Advantage	$6,967.14
Rate for Payer: Priority Health Choice Medicaid	$3,734.39
Rate for Payer: Priority Health Medicare	$6,967.14
Rate for Payer: Railroad Medicare Medicare	$6,967.14
Rate for Payer: UHC All Payor (Choice/PPO)	$19,611.80
Rate for Payer: UHC Dual Complete DSNP	$6,967.14
Rate for Payer: UHC Exchange	$13,314.90
Rate for Payer: UHC Medicare Advantage	$6,967.14
Rate for Payer: UHCCP Medicaid	$3,734.39
Rate for Payer: VA VA	$6,967.14

REMOVAL OF TISSUE EXPANDER WITHOUT INSERTION OF IMPLANT

Facility

$7,857.23

Service Code	CPT 11971
Hospital Revenue Code	360
Min. Negotiated Rate	$1,496.14
Max. Negotiated Rate	$7,857.23
Rate for Payer: Aetna Medicare	$2,902.95
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,489.12
Rate for Payer: Amish Plain Church Group Commercial	$3,489.12
Rate for Payer: BCBS Complete	$1,570.94
Rate for Payer: BCBS MAPPO	$2,791.30
Rate for Payer: BCN Medicare Advantage	$2,791.30
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,791.30
Rate for Payer: Mclaren Medicaid	$1,496.14
Rate for Payer: Mclaren Medicare	$2,791.30
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$2,930.86
Rate for Payer: Meridian Medicaid	$1,570.94
Rate for Payer: MI Amish Medical Board Commercial	$3,209.99
Rate for Payer: PACE Medicare	$2,651.74
Rate for Payer: PACE SWMI	$2,791.30
Rate for Payer: PHP Medicare Advantage	$2,791.30
Rate for Payer: Priority Health Choice Medicaid	$1,496.14
Rate for Payer: Priority Health Medicare	$2,791.30
Rate for Payer: Railroad Medicare Medicare	$2,791.30
Rate for Payer: UHC All Payor (Choice/PPO)	$7,857.23
Rate for Payer: UHC Dual Complete DSNP	$2,791.30
Rate for Payer: UHC Exchange	$5,334.45
Rate for Payer: UHC Medicare Advantage	$2,791.30
Rate for Payer: UHCCP Medicaid	$1,496.14
Rate for Payer: VA VA	$2,791.30

REMOVAL OF TUNNELED CENTRAL VENOUS ACCESS DEVICE, WITH SUBCUTANEOUS PORT OR PUMP, CENTRAL OR PERIPHERAL INSERTION

Facility

$4,264.69

Service Code	CPT 36590
Hospital Revenue Code	360
Min. Negotiated Rate	$812.06
Max. Negotiated Rate	$4,264.69
Rate for Payer: Aetna Medicare	$1,575.64
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,893.80
Rate for Payer: Amish Plain Church Group Commercial	$1,893.80
Rate for Payer: BCBS Complete	$852.66
Rate for Payer: BCBS MAPPO	$1,515.04
Rate for Payer: BCN Medicare Advantage	$1,515.04
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,515.04
Rate for Payer: Mclaren Medicaid	$812.06
Rate for Payer: Mclaren Medicare	$1,515.04
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,590.79
Rate for Payer: Meridian Medicaid	$852.66
Rate for Payer: MI Amish Medical Board Commercial	$1,742.30
Rate for Payer: PACE Medicare	$1,439.29
Rate for Payer: PACE SWMI	$1,515.04
Rate for Payer: PHP Medicare Advantage	$1,515.04
Rate for Payer: Priority Health Choice Medicaid	$812.06
Rate for Payer: Priority Health Medicare	$1,515.04
Rate for Payer: Railroad Medicare Medicare	$1,515.04
Rate for Payer: UHC All Payor (Choice/PPO)	$4,264.69
Rate for Payer: UHC Dual Complete DSNP	$1,515.04
Rate for Payer: UHC Exchange	$2,895.39
Rate for Payer: UHC Medicare Advantage	$1,515.04
Rate for Payer: UHCCP Medicaid	$812.06
Rate for Payer: VA VA	$1,515.04

REMOVAL OF TUNNELED CENTRAL VENOUS CATHETER, WITHOUT SUBCUTANEOUS PORT OR PUMP

Facility

$1,697.33

Service Code	CPT 36589
Hospital Revenue Code	360
Min. Negotiated Rate	$323.20
Max. Negotiated Rate	$1,697.33
Rate for Payer: Aetna Medicare	$627.10
Rate for Payer: Allen County Amish Medical Aid Commercial	$753.73
Rate for Payer: Amish Plain Church Group Commercial	$753.73
Rate for Payer: BCBS Complete	$339.36
Rate for Payer: BCBS MAPPO	$602.98
Rate for Payer: BCN Medicare Advantage	$602.98
Rate for Payer: Health Alliance Plan Medicare Advantage	$602.98
Rate for Payer: Mclaren Medicaid	$323.20
Rate for Payer: Mclaren Medicare	$602.98
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$633.13
Rate for Payer: Meridian Medicaid	$339.36
Rate for Payer: MI Amish Medical Board Commercial	$693.43
Rate for Payer: PACE Medicare	$572.83
Rate for Payer: PACE SWMI	$602.98
Rate for Payer: PHP Medicare Advantage	$602.98
Rate for Payer: Priority Health Choice Medicaid	$323.20
Rate for Payer: Priority Health Medicare	$602.98
Rate for Payer: Railroad Medicare Medicare	$602.98
Rate for Payer: UHC All Payor (Choice/PPO)	$1,697.33
Rate for Payer: UHC Dual Complete DSNP	$602.98
Rate for Payer: UHC Exchange	$1,152.36
Rate for Payer: UHC Medicare Advantage	$602.98
Rate for Payer: UHCCP Medicaid	$323.20
Rate for Payer: VA VA	$602.98

REMOVAL OF TUNNELED CENTRAL VENOUS CATHETER, WITHOUT SUBCUTANEOUS PORT OR PUMP

Facility

$1,697.33

Service Code	CPT 36589
Hospital Revenue Code	361
Min. Negotiated Rate	$323.20
Max. Negotiated Rate	$1,697.33
Rate for Payer: Aetna Medicare	$627.10
Rate for Payer: Allen County Amish Medical Aid Commercial	$753.73
Rate for Payer: Amish Plain Church Group Commercial	$753.73
Rate for Payer: BCBS Complete	$339.36
Rate for Payer: BCBS MAPPO	$602.98
Rate for Payer: BCN Medicare Advantage	$602.98
Rate for Payer: Health Alliance Plan Medicare Advantage	$602.98
Rate for Payer: Mclaren Medicaid	$323.20
Rate for Payer: Mclaren Medicare	$602.98
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$633.13
Rate for Payer: Meridian Medicaid	$339.36
Rate for Payer: MI Amish Medical Board Commercial	$693.43
Rate for Payer: PACE Medicare	$572.83
Rate for Payer: PACE SWMI	$602.98
Rate for Payer: PHP Medicare Advantage	$602.98
Rate for Payer: Priority Health Choice Medicaid	$323.20
Rate for Payer: Priority Health Medicare	$602.98
Rate for Payer: Railroad Medicare Medicare	$602.98
Rate for Payer: UHC All Payor (Choice/PPO)	$1,697.33
Rate for Payer: UHC Dual Complete DSNP	$602.98
Rate for Payer: UHC Exchange	$1,152.36
Rate for Payer: UHC Medicare Advantage	$602.98
Rate for Payer: UHCCP Medicaid	$323.20
Rate for Payer: VA VA	$602.98

REMOVAL OF TUNNELED INTRAPERITONEAL CATHETER

Facility

$8,640.87

Service Code	CPT 49422
Hospital Revenue Code	360
Min. Negotiated Rate	$1,645.35
Max. Negotiated Rate	$8,640.87
Rate for Payer: Aetna Medicare	$3,192.48
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,837.11
Rate for Payer: Amish Plain Church Group Commercial	$3,837.11
Rate for Payer: BCBS Complete	$1,727.62
Rate for Payer: BCBS MAPPO	$3,069.69
Rate for Payer: BCN Medicare Advantage	$3,069.69
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,069.69
Rate for Payer: Mclaren Medicaid	$1,645.35
Rate for Payer: Mclaren Medicare	$3,069.69
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$3,223.17
Rate for Payer: Meridian Medicaid	$1,727.62
Rate for Payer: MI Amish Medical Board Commercial	$3,530.14
Rate for Payer: PACE Medicare	$2,916.21
Rate for Payer: PACE SWMI	$3,069.69
Rate for Payer: PHP Medicare Advantage	$3,069.69
Rate for Payer: Priority Health Choice Medicaid	$1,645.35
Rate for Payer: Priority Health Medicare	$3,069.69
Rate for Payer: Railroad Medicare Medicare	$3,069.69
Rate for Payer: UHC All Payor (Choice/PPO)	$8,640.87
Rate for Payer: UHC Dual Complete DSNP	$3,069.69
Rate for Payer: UHC Exchange	$5,866.48
Rate for Payer: UHC Medicare Advantage	$3,069.69
Rate for Payer: UHCCP Medicaid	$1,645.35
Rate for Payer: VA VA	$3,069.69

REMOVAL OF VITREOUS, ANTERIOR APPROACH (OPEN SKY TECHNIQUE OR LIMBAL INCISION); PARTIAL REMOVAL

Facility

$6,261.32

Service Code	CPT 67005
Hospital Revenue Code	360
Min. Negotiated Rate	$1,192.25
Max. Negotiated Rate	$6,261.32
Rate for Payer: Aetna Medicare	$2,313.32
Rate for Payer: Allen County Amish Medical Aid Commercial	$2,780.44
Rate for Payer: Amish Plain Church Group Commercial	$2,780.44
Rate for Payer: BCBS Complete	$1,251.86
Rate for Payer: BCBS MAPPO	$2,224.35
Rate for Payer: BCN Medicare Advantage	$2,224.35
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,224.35
Rate for Payer: Mclaren Medicaid	$1,192.25
Rate for Payer: Mclaren Medicare	$2,224.35
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$2,335.57
Rate for Payer: Meridian Medicaid	$1,251.86
Rate for Payer: MI Amish Medical Board Commercial	$2,558.00
Rate for Payer: PACE Medicare	$2,113.13
Rate for Payer: PACE SWMI	$2,224.35
Rate for Payer: PHP Medicare Advantage	$2,224.35
Rate for Payer: Priority Health Choice Medicaid	$1,192.25
Rate for Payer: Priority Health Medicare	$2,224.35
Rate for Payer: Railroad Medicare Medicare	$2,224.35
Rate for Payer: UHC All Payor (Choice/PPO)	$6,261.32
Rate for Payer: UHC Dual Complete DSNP	$2,224.35
Rate for Payer: UHC Exchange	$4,250.96
Rate for Payer: UHC Medicare Advantage	$2,224.35
Rate for Payer: UHCCP Medicaid	$1,192.25
Rate for Payer: VA VA	$2,224.35

REMOVAL OF VITREOUS, ANTERIOR APPROACH (OPEN SKY TECHNIQUE OR LIMBAL INCISION); SUBTOTAL REMOVAL WITH MECHANICAL VITRECTOMY

Facility

$6,261.32

Service Code	CPT 67010
Hospital Revenue Code	360
Min. Negotiated Rate	$1,192.25
Max. Negotiated Rate	$6,261.32
Rate for Payer: Aetna Medicare	$2,313.32
Rate for Payer: Allen County Amish Medical Aid Commercial	$2,780.44
Rate for Payer: Amish Plain Church Group Commercial	$2,780.44
Rate for Payer: BCBS Complete	$1,251.86
Rate for Payer: BCBS MAPPO	$2,224.35
Rate for Payer: BCN Medicare Advantage	$2,224.35
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,224.35
Rate for Payer: Mclaren Medicaid	$1,192.25
Rate for Payer: Mclaren Medicare	$2,224.35
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$2,335.57
Rate for Payer: Meridian Medicaid	$1,251.86
Rate for Payer: MI Amish Medical Board Commercial	$2,558.00
Rate for Payer: PACE Medicare	$2,113.13
Rate for Payer: PACE SWMI	$2,224.35
Rate for Payer: PHP Medicare Advantage	$2,224.35
Rate for Payer: Priority Health Choice Medicaid	$1,192.25
Rate for Payer: Priority Health Medicare	$2,224.35
Rate for Payer: Railroad Medicare Medicare	$2,224.35
Rate for Payer: UHC All Payor (Choice/PPO)	$6,261.32
Rate for Payer: UHC Dual Complete DSNP	$2,224.35
Rate for Payer: UHC Exchange	$4,250.96
Rate for Payer: UHC Medicare Advantage	$2,224.35
Rate for Payer: UHCCP Medicaid	$1,192.25
Rate for Payer: VA VA	$2,224.35

REMOVAL OR REPAIR OF ELECTROMAGNETIC BONE CONDUCTION HEARING DEVICE IN TEMPORAL BONE

Facility

$8,903.25

Service Code	CPT 69711
Hospital Revenue Code	360
Min. Negotiated Rate	$1,695.31
Max. Negotiated Rate	$8,903.25
Rate for Payer: Aetna Medicare	$3,289.42
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,953.62
Rate for Payer: Amish Plain Church Group Commercial	$3,953.62
Rate for Payer: BCBS Complete	$1,780.08
Rate for Payer: BCBS MAPPO	$3,162.90
Rate for Payer: BCN Medicare Advantage	$3,162.90
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,162.90
Rate for Payer: Mclaren Medicaid	$1,695.31
Rate for Payer: Mclaren Medicare	$3,162.90
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$3,321.05
Rate for Payer: Meridian Medicaid	$1,780.08
Rate for Payer: MI Amish Medical Board Commercial	$3,637.34
Rate for Payer: PACE Medicare	$3,004.76
Rate for Payer: PACE SWMI	$3,162.90
Rate for Payer: PHP Medicare Advantage	$3,162.90
Rate for Payer: Priority Health Choice Medicaid	$1,695.31
Rate for Payer: Priority Health Medicare	$3,162.90
Rate for Payer: Railroad Medicare Medicare	$3,162.90
Rate for Payer: UHC All Payor (Choice/PPO)	$8,903.25
Rate for Payer: UHC Dual Complete DSNP	$3,162.90
Rate for Payer: UHC Exchange	$6,044.62
Rate for Payer: UHC Medicare Advantage	$3,162.90
Rate for Payer: UHCCP Medicaid	$1,695.31
Rate for Payer: VA VA	$3,162.90

REMOVAL OR REVISION OF SLING FOR STRESS INCONTINENCE (EG, FASCIA OR SYNTHETIC)

Facility

$8,728.81

Service Code	CPT 57287
Hospital Revenue Code	360
Min. Negotiated Rate	$1,662.10
Max. Negotiated Rate	$8,728.81
Rate for Payer: Aetna Medicare	$3,224.97
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,876.16
Rate for Payer: Amish Plain Church Group Commercial	$3,876.16
Rate for Payer: BCBS Complete	$1,745.20
Rate for Payer: BCBS MAPPO	$3,100.93
Rate for Payer: BCN Medicare Advantage	$3,100.93
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,100.93
Rate for Payer: Mclaren Medicaid	$1,662.10
Rate for Payer: Mclaren Medicare	$3,100.93
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$3,255.98
Rate for Payer: Meridian Medicaid	$1,745.20
Rate for Payer: MI Amish Medical Board Commercial	$3,566.07
Rate for Payer: PACE Medicare	$2,945.88
Rate for Payer: PACE SWMI	$3,100.93
Rate for Payer: PHP Medicare Advantage	$3,100.93
Rate for Payer: Priority Health Choice Medicaid	$1,662.10
Rate for Payer: Priority Health Medicare	$3,100.93
Rate for Payer: Railroad Medicare Medicare	$3,100.93
Rate for Payer: UHC All Payor (Choice/PPO)	$8,728.81
Rate for Payer: UHC Dual Complete DSNP	$3,100.93
Rate for Payer: UHC Exchange	$5,926.19
Rate for Payer: UHC Medicare Advantage	$3,100.93
Rate for Payer: UHCCP Medicaid	$1,662.10
Rate for Payer: VA VA	$3,100.93

REMOVAL, UNDER ANESTHESIA, OF EXTERNAL FIXATION SYSTEM

Facility

$4,393.64

Service Code	CPT 20694
Hospital Revenue Code	360
Min. Negotiated Rate	$836.62
Max. Negotiated Rate	$4,393.64
Rate for Payer: Aetna Medicare	$1,623.28
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,951.06
Rate for Payer: Amish Plain Church Group Commercial	$1,951.06
Rate for Payer: BCBS Complete	$878.45
Rate for Payer: BCBS MAPPO	$1,560.85
Rate for Payer: BCN Medicare Advantage	$1,560.85
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,560.85
Rate for Payer: Mclaren Medicaid	$836.62
Rate for Payer: Mclaren Medicare	$1,560.85
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,638.89
Rate for Payer: Meridian Medicaid	$878.45
Rate for Payer: MI Amish Medical Board Commercial	$1,794.98
Rate for Payer: PACE Medicare	$1,482.81
Rate for Payer: PACE SWMI	$1,560.85
Rate for Payer: PHP Medicare Advantage	$1,560.85
Rate for Payer: Priority Health Choice Medicaid	$836.62
Rate for Payer: Priority Health Medicare	$1,560.85
Rate for Payer: Railroad Medicare Medicare	$1,560.85
Rate for Payer: UHC All Payor (Choice/PPO)	$4,393.64
Rate for Payer: UHC Dual Complete DSNP	$1,560.85
Rate for Payer: UHC Exchange	$2,982.94
Rate for Payer: UHC Medicare Advantage	$1,560.85
Rate for Payer: UHCCP Medicaid	$836.62
Rate for Payer: VA VA	$1,560.85

REMOVAL WITH REINSERTION, NON-BIODEGRADABLE DRUG DELIVERY IMPLANT

Facility

$1,095.50

Service Code	CPT 11983
Hospital Revenue Code	360
Min. Negotiated Rate	$208.60
Max. Negotiated Rate	$1,095.50
Rate for Payer: Aetna Medicare	$404.75
Rate for Payer: Allen County Amish Medical Aid Commercial	$486.48
Rate for Payer: Amish Plain Church Group Commercial	$486.48
Rate for Payer: BCBS Complete	$219.03
Rate for Payer: BCBS MAPPO	$389.18
Rate for Payer: BCN Medicare Advantage	$389.18
Rate for Payer: Health Alliance Plan Medicare Advantage	$389.18
Rate for Payer: Mclaren Medicaid	$208.60
Rate for Payer: Mclaren Medicare	$389.18
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$408.64
Rate for Payer: Meridian Medicaid	$219.03
Rate for Payer: MI Amish Medical Board Commercial	$447.56
Rate for Payer: PACE Medicare	$369.72
Rate for Payer: PACE SWMI	$389.18
Rate for Payer: PHP Medicare Advantage	$389.18
Rate for Payer: Priority Health Choice Medicaid	$208.60
Rate for Payer: Priority Health Medicare	$389.18
Rate for Payer: Railroad Medicare Medicare	$389.18
Rate for Payer: UHC All Payor (Choice/PPO)	$1,095.50
Rate for Payer: UHC Dual Complete DSNP	$389.18
Rate for Payer: UHC Exchange	$743.76
Rate for Payer: UHC Medicare Advantage	$389.18
Rate for Payer: UHCCP Medicaid	$208.60
Rate for Payer: VA VA	$389.18

REPAGLINIDE 1 MG TABLET

Facility

$213.85

Service Code	NDC 57237015801
Hospital Charge Code	22586
Hospital Revenue Code	637
Min. Negotiated Rate	$79.12
Max. Negotiated Rate	$192.47
Rate for Payer: Aetna American Axle	$139.00
Rate for Payer: Aetna Commercial	$181.77
Rate for Payer: Aetna Medicare	$106.92
Rate for Payer: Aetna New Business (MI Preferred)	$139.00
Rate for Payer: BCBS Complete	$85.54
Rate for Payer: Cash Price	$171.08
Rate for Payer: Cofinity Commercial	$149.69
Rate for Payer: Cofinity Commercial	$183.91
Rate for Payer: Cofinity Medicare Advantage	$149.69
Rate for Payer: Encore Health Key Benefits Commercial	$171.08
Rate for Payer: Healthscope Commercial	$192.47
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$149.69
Rate for Payer: Lakeland Regional Health Systems Commercial	$160.39
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$181.77
Rate for Payer: PHP Commercial	$181.77
Rate for Payer: Priority Health Cigna Priority Health	$139.00
Rate for Payer: Priority Health SBD	$134.73
Rate for Payer: UMR Bronson Commercial	$79.12
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$160.39

Know your out-of-pocket cost for care.

All Charges